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  • 1
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    A NADE nomogram to predict the probability of 6-month unfavorable outcome in Chinese patients with ischemic stroke
    Springer Science and Business Media LLC ; 2019
    In:  BMC Neurology Vol. 19, No. 1 ( 2019-12)
    Details
    In: BMC Neurology, Springer Science and Business Media LLC, Vol. 19, No. 1 ( 2019-12)
    Abstract: Early prediction of unfavorable outcome after ischemic stroke is of great significance to the clinical and therapeutic management. A nomogram is a better visual tool than earlier models and prognostic scores to predict clinical outcomes, which incorporates different factors to develop a graphic continuous scoring system and calculates accurately the risk probability of poor outcome entirely based on individual characteristics. However, to date, no nomogram models have been found to predict the probability of 6-month poor outcome after ischemic stroke. We aimed to develop and validate a nomogram for individualized prediction of the probability of 6-month unfavorable outcome in Chinese patients with ischemic stroke. Methods Based on the retrospective stroke registry, a single-center study which included 499 patients from May, 2013 to May, 2018 was conducted in Nanjing First Hospital (China) for ischemic stroke within 12 h of symptoms onset. The main outcome measure was 6-month unfavorable outcome (mRS  〉  2). To generate the nomogram, N IHSS score on admission, A ge, previous D iabetes mellitus and cr E atinine (NADE) were integrated into the model. We assessed the discriminative performance by using the area under the curve (AUC) of receiver-operating characteristic (ROC) and calibration of risk prediction model by using the Hosmer–Lemeshow test. Results A visual NADE nomogram was constructed that NIHSS score on admission (OR: 1.190, 95%CI: 1.125–1.258), age (OR: 1.068, 95%CI: 1.045–1.090), previous diabetes mellitus (OR: 1.995, 95%CI: 1.236–3.221) and creatinine (OR: 1.010, 95%CI: 1.002–1.018) were found to be significant predictors of 6-month unfavorable outcome after acute ischemic stroke in Chinese patients. The AUC–ROC of nomogram was 0.791. Calibration was good ( p  = 0.4982 for the Hosmer–Lemeshow test). Conclusion The NADE is the first nomogram developed and validated in Chinese ischemic stroke patients to provide an individual, visual and precise prediction of the risk probability of 6-month unfavorable outcome.
    Type of Medium: Online Resource
    ISSN: 1471-2377
    URL: Article
    DOI: 10.1186/s12883-019-1464-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2041347-6
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  • 2
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    Data_Sheet_1.docx
    Frontiers Media SA ; 2020
    In:  Frontiers in Neurology Vol. 11 ( 2020-11-19)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 11 ( 2020-11-19)
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    URL: Article
    DOI: 10.3389/fneur.2020.539509
    DOI: 10.3389/fneur.2020.539509.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2020
    detail.hit.zdb_id: 2564214-5
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  • 3
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    Table_1.XLSX
    Frontiers Media SA ; 2022
    In:  Frontiers in Neurology Vol. 13 ( 2022-8-19)
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    In: Frontiers in Neurology, Frontiers Media SA, Vol. 13 ( 2022-8-19)
    Abstract: Futile recanalization occurs when the endovascular thrombectomy (EVT) is a technical success but fails to achieve a favorable outcome. This study aimed to use machine learning (ML) algorithms to develop a pre-EVT model and a post-EVT model to predict the risk of futile recanalization and to provide meaningful insights to assess the prognostic factors associated with futile recanalization. Methods Consecutive acute ischemic stroke patients with large vessel occlusion (LVO) undergoing EVT at the National Advanced Stroke Center of Nanjing First Hospital (China) between April 2017 and May 2021 were analyzed. The baseline characteristics and peri-interventional characteristics were assessed using four ML algorithms. The predictive performance was evaluated by the area under curve (AUC) of receiver operating characteristic and calibration curve. In addition, the SHapley Additive exPlanations (SHAP) approach and partial dependence plot were introduced to understand the relative importance and the influence of a single feature. Results A total of 312 patients were included in this study. Of the four ML models that include baseline characteristics, the “Early” XGBoost had a better performance {AUC, 0.790 [95% confidence intervals (CI), 0.677–0.903]; Brier, 0.191}. Subsequent inclusion of peri-interventional characteristics into the “Early” XGBoost showed that the “Late” XGBoost performed better [AUC, 0.910 (95% CI, 0.837–0.984); Brier, 0.123] . NIHSS after 24 h, age, groin to recanalization, and the number of passages were the critical prognostic factors associated with futile recanalization, and the SHAP approach shows that NIHSS after 24 h ranks first in relative importance. Conclusions The “Early” XGBoost and the “Late” XGBoost allowed us to predict futile recanalization before and after EVT accurately. Our study suggests that including peri-interventional characteristics may lead to superior predictive performance compared to a model based on baseline characteristics only. In addition, NIHSS after 24 h was the most important prognostic factor for futile recanalization.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fneur.2022.909403
    DOI: 10.3389/fneur.2022.909403.s001
    DOI: 10.3389/fneur.2022.909403.s002
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
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  • 4
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    Interpretable Machine Learning Model Predicting Early Neurological Deterioration in Ischemic Stroke Patients Treated with Mechanical Thrombectomy: A Retrospective Study
    MDPI AG ; 2023
    In:  Brain Sciences Vol. 13, No. 4 ( 2023-03-26), p. 557-
    Details
    In: Brain Sciences, MDPI AG, Vol. 13, No. 4 ( 2023-03-26), p. 557-
    Abstract: Early neurologic deterioration (END) is a common and feared complication for acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT). This study aimed to develop an interpretable machine learning (ML) model for individualized prediction to predict END in AIS patients treated with MT. The retrospective cohort of AIS patients who underwent MT was from two hospitals. ML methods applied include logistic regression (LR), random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGBoost). The area under the receiver operating characteristic curve (AUC) was the main evaluation metric used. We also used Shapley Additive Explanation (SHAP) and Local Interpretable Model-Agnostic Explanations (LIME) to interpret the result of the prediction model. A total of 985 patients were enrolled in this study, and the development of END was noted in 157 patients (15.9%). Among the used models, XGBoost had the highest prediction power (AUC = 0.826, 95% CI 0.781–0.871). The Delong test and calibration curve indicated that XGBoost significantly surpassed those of the other models in prediction. In addition, the AUC in the validating set was 0.846, which showed a good performance of the XGBoost. The SHAP method revealed that blood glucose was the most important predictor variable. The constructed interpretable ML model can be used to predict the risk probability of END after MT in AIS patients. It may help clinical decision making in the perioperative period of AIS patients treated with MT.
    Type of Medium: Online Resource
    ISSN: 2076-3425
    URL: Article
    DOI: 10.3390/brainsci13040557
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2651993-8
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  • 5
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    Safety and efficacy of early antiplatelet therapy in acute ischemic stroke patients receiving endovascular treatment: A systematic review and meta-analysis
    Elsevier BV ; 2019
    In:  Journal of Clinical Neuroscience Vol. 66 ( 2019-08), p. 45-50
    Details
    In: Journal of Clinical Neuroscience, Elsevier BV, Vol. 66 ( 2019-08), p. 45-50
    Type of Medium: Online Resource
    ISSN: 0967-5868
    URL: Article
    DOI: 10.1016/j.jocn.2019.05.028
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
    detail.hit.zdb_id: 2009190-4
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  • 6
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    Influence of renal function on stroke outcome after mechanical thrombectomy: a prospective cohort study
    Springer Science and Business Media LLC ; 2020
    In:  BMC Neurology Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Neurology, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: For acute ischemic stroke (AIS) patient receiving mechanical thrombectomy (MT), renal dysfunction was an independent risk factor of contrast-induced nephropathy which may affect clinical outcomes. However, the influence of renal function on stroke outcomes is still controversial. Thus, we aim to investigate the association between renal function and outcomes of AIS patients receiving MT. Methods All consecutive stroke patients receiving MT were included in a prospective stroke registry in China from April 2015 to February 2019. Estimated glomerular filtration rate (eGFR) was measured on admission and categorized into G1 (≥ 90 ml/min/1.73 m 2 ), G2 (60–89 ml/min/1.73 m 2 ), G3a (45–59 ml/min/1.73 m 2 ) and G3b-5 (≤44 ml/min/1.73 m 2 ). Multivariable logistic regression analysis was performed to evaluate the association between eGFR and recanalization rate (thrombolysis in cerebral infarction scale 2b-3), symptomatic intracranial hemorrhage (sICH), death in hospital, death at 3 months and poor functional outcome (modified Rankin Scale 3–6 at 3 months). Results A total of 373 patients were included in the study. Of them, 130 (34.9%) patients were in the eGFR group G1, 170 (45.6%) in G2, 46 (12.3%) in G3a, 27 (7.2%) in G3b–5. In multivariable logistic regression analysis, reduced eGFR was associated with increased risk of sICH (G3a, p  = 0.016) and 3-month death (G3b–5, p  = 0.025). However, no significant effects were observed between reduced eGFR and the risk of recanalization rate ( p  = 0.855), death in hospital ( p  = 0.970), and poor functional outcome ( p  = 0.644). Conclusions For AIS patients underwent MT, reduced eGFR was associated with increased risk of sICH and 3-month death. However, there were no appreciable effects of reduced eGFR on recanalization rate, death in hospital and 3-month functional outcome.
    Type of Medium: Online Resource
    ISSN: 1471-2377
    URL: Article
    DOI: 10.1186/s12883-020-01720-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2041347-6
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  • 7
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    Influence of tirofiban on stroke outcome after mechanical thrombectomy in acute vertebrobasilar artery occlusion
    Springer Science and Business Media LLC ; 2022
    In:  BMC Neurology Vol. 22, No. 1 ( 2022-12-09)
    Details
    In: BMC Neurology, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-12-09)
    Abstract: Even undergoing mechanical thrombectomy (MT), patients with acute vertebrobasilar artery occlusion (AVBAO) still have a high rate of mortality. Tirofiban is a novel antiplatelet agent which is now widely empirically used in acute ischemic stroke (AIS). In this study, we aimed to evaluate the safety and efficacy of tirofiban as adjunctive therapy for MT in AVBAO. Methods From October 2016 to July 2021, consecutive AVBAO patients receiving MT were included in the prospective stroke registry. The short-term outcomes were (1) symptomatic intracerebral hemorrhage (sICH); (2) in-hospital death; (3) National Institute of Health Stroke Scale (NIHSS) at discharge. The Long-term outcomes were: (1) modified Rankin Scale (mRS) at 3 months; (2) death at 3 months. Results A total of 130 eligible patients were included in the study, 64 (49.2%) patients received tirofiban. In multivariate regression analysis, no significant differences were observed in all outcomes between the tirofiban and non-tirofiban group [sICH (adjusted OR 0.96; 95% CI, 0.12–7.82, p  = 0.97), in-hospital death (adjusted OR 0.57; 95% CI, 0.17–1.89, p  = 0.36), NIHSS at discharge (95% CI, -2.14–8.63, p  = 0.24), mRS (adjusted OR 1.20; 95% CI, 0.40–3.62, p  = 0.75), and death at 3 months (adjusted OR 0.83; 95% CI, 0.24–2.90, p  = 0.77)]. Conclusions In AVBAO, tirofiban adjunctive to MT was not associated with an increased risk of sICH. Short-term (in-hospital death, NIHSS at discharge) and long-term outcomes (mRS and death at 3 months) seem not to be influenced by tirofiban use.
    Type of Medium: Online Resource
    ISSN: 1471-2377
    URL: Article
    DOI: 10.1186/s12883-022-02996-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 8
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    Data_Sheet_1.CSV
    Frontiers Media SA ; 2023
    In:  Frontiers in Neuroscience Vol. 16 ( 2023-1-10)
    Details
    In: Frontiers in Neuroscience, Frontiers Media SA, Vol. 16 ( 2023-1-10)
    Abstract: Aneurysmal subarachnoid hemorrhage (aSAH) is a significant cause of morbidity and mortality throughout the world. Dynamic nomogram to predict the prognosis of elderly aSAH patients after endovascular coiling has not been reported. Thus, we aimed to develop a clinically useful dynamic nomogram to predict the risk of 6-month unfavorable outcome in elderly aSAH patients after endovascular coiling. Methods We conducted a retrospective study including 209 elderly patients admitted to the People’s Hospital of Hunan Province for aSAH from January 2016 to June 2021. The main outcome measure was 6-month unfavorable outcome (mRS ≥ 3). We used multivariable logistic regression analysis and forwarded stepwise regression to select variables to generate the nomogram. We assessed the discriminative performance using the area under the curve (AUC) of receiver-operating characteristic and the risk prediction model’s calibration using the Hosmer–Lemeshow goodness-of-fit test. The decision curve analysis (DCA) and the clinical impact curve (CIC) were used to measure the clinical utility of the nomogram. Results The cohort’s median age was 70 (interquartile range: 68–74) years and 133 (36.4%) had unfavorable outcomes. Age, using a ventilator, white blood cell count, and complicated with cerebral infarction were predictors of 6-month unfavorable outcome. The AUC of the nomogram was 0.882 and the Hosmer–Lemeshow goodness-of-fit test showed good calibration of the nomogram ( p = 0.3717). Besides, the excellent clinical utility and applicability of the nomogram had been indicated by DCA and CIC. The eventual value of unfavorable outcome risk could be calculated through the dynamic nomogram. Conclusion This study is the first visual dynamic online nomogram that accurately predicts the risk of 6-month unfavorable outcome in elderly aSAH patients after endovascular coiling. Clinicians can effectively improve interventions by taking targeted interventions based on the scores of different items on the nomogram for each variable.
    Type of Medium: Online Resource
    ISSN: 1662-453X
    URL: Article
    URL: Article
    DOI: 10.3389/fnins.2022.1037895
    DOI: 10.3389/fnins.2022.1037895.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
    detail.hit.zdb_id: 2411902-7
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  • 9
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    Prior Antiplatelet Agent Use and Outcomes after Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke: A Meta-Analysis of Cohort Studies and Randomized Controlled Trials
    SAGE Publications ; 2015
    In:  International Journal of Stroke Vol. 10, No. 3 ( 2015-04), p. 317-323
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 10, No. 3 ( 2015-04), p. 317-323
    Abstract: There is uncertainty surrounding the influence of prior antiplatelet agent use on outcomes after intravenous thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke. Aim We performed a systematic review with a final meta-analysis to evaluate the efficacy and safety of prior antiplatelet use before intravenous recombinant tissue plasminogen activator for acute ischemic stroke. Summary of review We searched PubMed and Embase databases from 1997 to 2014. Primary outcome was functional outcome at the end of follow-up; secondary outcomes were symptomatic intracranial hemorrhage and recanalization rate. The meta-analysis was performed with Review Manager 5·2 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012). Eleven studies with a total of 19 453 patients were included. A total of 6517 (33·5%) patients who had received intravenous recombinant tissue plasminogen activator were taking antiplatelet agent before stroke onset. Pooled analysis demonstrated a clear trend that previous anti-platelet users had a reduced probability of good outcome, although it was not conventionally statistically significant (OR 0·86; 95% CI 0·73–1·01; P = 0·06). There was no difference in recanalization rate between two groups (OR 1·23; 95% CI 0·30–4·99; P = 0·77). The risk of symptomatic intracranial hemorrhage was significantly increased in the antiplatelet group (OR 1·65; 95% CI 1·44–1·90; P 〈 0·01). Conclusions In acute ischemic stroke patients receiving intravenous recombinant tissue plasminogen activator therapy, prior antiplatelet agent use did not lead to a significant difference in functional outcome, although it significantly increased the risk of symptomatic intracranial hemorrhage. Recanalization rate was not different between two groups. In the subgroup analysis, prior clopidogrel mono therapy may not increase the risk of symptomatic intracranial hemorrhage, which will need further studies to confirm.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1111/ijs.12431
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2211666-7
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  • 10
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    Prior antiplatelet agent use and outcomes after intravenous thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke: A meta-analysis
    Elsevier BV ; 2017
    In:  Journal of Stroke and Cerebrovascular Diseases Vol. 26, No. 4 ( 2017-04), p. 880-
    Details
    In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 26, No. 4 ( 2017-04), p. 880-
    Type of Medium: Online Resource
    ISSN: 1052-3057
    URL: Article
    DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.022
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2017
    detail.hit.zdb_id: 2052957-0
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